J Gynecol Oncol.  2010 Sep;21(3):163-168. 10.3802/jgo.2010.21.3.163.

Survival benefit of laparoscopic surgical staging-guided radiation therapy in locally advanced cervical cancer

• Hong DG
• Park NY
• Chong GO
• Cho YL
• Park IS
• Lee YS

• KMID: 1980852
• DOI: http://doi.org/10.3802/jgo.2010.21.3.163

Abstract

OBJECTIVE
This study was designed to evaluate the survival benefit of laparoscopic surgical staging (LSS)-guided tailored radiation therapy (RT) in locally advanced cervical cancer (LACC).
METHODS
We retrospectively reviewed 89 LACC patients' medical records who primarily received non-surgical treatment, of which pretreatment LSS was performed in 20 (LSS group) and primary chemoradiation therapy (CCRT) without LSS (CCRT group) was carried out in 69 from January 2000 to January 2006. We analyzed clinical characteristics, pretreatment imaging study results and survival outcomes including disease free survival (DFS) and overall survival (OS) to compare them between the two groups.
RESULTS
There were as many as eight cases (40%) of LSS related complications. The mean time interval between LSS and RT or CCRT was 26.6 days (+/-18.8 days). Six out of twenty (30%) in LSS group and 10 out of 69 (14.5%) in CCRT group received extended field RT when paraaortic lymph nodes (LNs) were positive based on the pathologic findings after LSS and the results of imaging studies, respectively. Three-year DFS and OS were both better in 33 imaging-negative CCRT group patients than those in 4 imaging-negative/pathology-positive (false negative) patients after LSS (3-year DFS, 50% vs. 87%, p=0.022; 3-year OS, 50% vs. 84%, p=0.033). The 5-year DFS rates were 52% and 55% in LSS group and in CCRT group, respectively (p=0.28). The 5-year OS rates were 68% in LSS group and 62% in CCRT group without significant difference between the two groups (p=0.79).
CONCLUSION
We found that LSS-based RT tailoring did not show survival benefit in LACC despite inaccuracy of imaging-based RT tailoring. Further studies are required to find new method to overcome this inaccuracy and improve survival outcomes.

Keyword

Cervical carcinoma; Laparoscopy; Surgical staging; Chemoradiation

MeSH Terms

Disease-Free Survival
Humans
Laparoscopy
Lymph Nodes
Medical Records
Retrospective Studies
Uterine Cervical Neoplasms

Figure

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  Fig. 1 Paraaortic and pelvic lymphadenectomy (A: left renal vein, B: vena cava, C: aorta, D: inferior mesenteric artery, E: both common iliac artery, F: right ureter).

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  Fig. 2 (A) Five-year disease-free survival rate in laparoscopic surgical staging and primary concurrent cheomoradiation group. (B) Five-year overall survival rate in laparoscopic surgical staging and primary concurrent chemoradiation group.

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